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To the Editor: Drs Sirovich and Welch¹ report that approximately 10 million US women, or almost half of those who have undergone a hysterectomy and therefore have no cervix, are undergoing Pap smear screening for cancer of the cervix. They have brought attention to a procedure that is unnecessary in women who are no longer at risk of cervical cancer. Vaginal cancer is so rare that there is virtually no secondary benefit of cytologic screening in these women. Thus, either patients or the US health care system incurs costs for unnecessary screening: conventional Pap smears cost $15 and new, more sensitive screening methods such as liquid-based cytology ($28 per test) and human papillomavirus (HPV) testing ($48.50 per test) are even more expensive.² Eliminating Pap smear screening in these women would be cost-effective.

It is noteworthy that the absence of a cervix does not preclude women who have undergone hysterectomy from . . . [Full Text of this Article]

Philip Castle, PhD, MPH
castlep@mail.nih.gov
Division of Cancer Epidemiology and Genetics
National Cancer Institute
Bethesda, Md

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